Fig. 3

Mechanisms involved in hypofibrinolysis in diabetes. The main factors influencing hypofibrinolysis in diabetes include altered fibrin network structure and an impaired fibrinolytic system. Factors contributing to altered clot structure include elevated levels of thrombin, and both quantitative and qualitative alterations in fibrinogen, including glycation and oxidation of fibrinogen molecules. Elevated levels of plasminogen activator inhibitor (PAI-1), glycation of plasminogen and increased incorporation of antifibrinolytic proteins plasmin inhibitor (PI) and complement C3 into clots in individuals with diabetes all contribute to impaired fibrinolysis. Levels of thrombin activatable fibrinolysis inhibitor (TAFI) can be raised in diabetes but studies are conflicting with some showing no change. Scale bar 5 μm. ↑, increase; →, no change